Active NPI
Johnathan Carl Parks, DMD
- Dentist
- Palmetto, FL
National Provider Identifier
1033735923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 25093
- Practice address
- 9430 Buffalo Rd
Palmetto, FL 34221-8687 - Phone
- (866) 929-0040
- NPI assigned
- Jun 17, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 25093 | FL | Primary |
Addresses
Primary practice location
9430 Buffalo Rd
Palmetto, FL 34221-8687
Mailing address
8501 Cache Dr
Sarasota, FL 34240-2710
Phone (561) 459-0947
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200810002643 | FL | Order and Referring Only - Dentist | 6103241906 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25093 | FL | MD | Dentist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628380800000",
"number": "1033735923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8501 CACHE DR",
"city": "SARASOTA",
"state": "FL",
"postal_code": "342402710",
"telephone_number": "561-459-0947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9430 BUFFALO RD",
"city": "PALMETTO",
"state": "FL",
"postal_code": "342218687",
"telephone_number": "866-929-0040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARKS",
"first_name": "JOHNATHAN",
"middle_name": "CARL",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-06-17",
"last_updated": "2021-08-08",
"certification_date": "2021-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "25093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palmetto, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.